Journal Articles

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    Bone Health in Premenopausal Women with Coeliac Disease: An Observational Study.
    (MDPI (Basel, Switzerland), 2024-07-09) Schraders K; Coad J; Kruger M; Iacone R
    Low bone mineral density (BMD) is common in adults with coeliac disease (CD), even in individuals adhering to a gluten-free diet (GFD). Women are more likely to have low BMD and have an increased risk of osteoporosis, so women with pre-existing low BMD related to CD are at an even higher risk. BMD assessed by dual X-ray absorptiometry (DXA) and bone quality assessed through quantitative ultrasound (QUS) were investigated in 31 premenopausal women with CD consuming a GFD, and 39 matched healthy controls from the Lower North Island, New Zealand. In addition, bone metabolism and nutrient status were assessed, and four-day diet diaries were used to estimate nutrient intake. No statistically significant differences were found in BMD assessed by DXA between the two groups at the hip, lumbar spine or forearm. However, the parameters measured by the QUS were significantly lower in CD participants. Dietary data indicated significantly lower intakes of energy, dietary fibre, magnesium and phosphorus in women with CD, likely as a result of a reduced intake of wholegrain foods, and suggested that both groups had inadequate intake of calcium. No significant differences were demonstrated in biochemical parameters. BMD and bone biomarkers indicated no differences between coeliac and healthy women in New Zealand. However, these findings suggest that QUS may be more sensitive for the coeliac population, due to the disease's affect on the trabecular bone, and warrant further research.
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    Gluten Induces Subtle Histological Changes in Duodenal Mucosa of Patients with Non-Coeliac Gluten Sensitivity: A Multicentre Study
    (MDPI (Basel, Switzerland), 2022-06-15) Rostami K; Ensari A; Marsh MN; Srivastava A; Villanacci V; Carroccio A; Asadzadeh Aghdaei H; Bai JC; Bassotti G; Becheanu G; Bell P; Di Bella C; Bozzola AM; Cadei M; Casella G; Catassi C; Ciacci C; Apostol Ciobanu DG; Cross SS; Danciu M; Das P; Del Sordo R; Drage M; Elli L; Fasano A; Florena AM; Fusco N; Going JJ; Guandalini S; Hagen CE; Hayman DTS; Ishaq S; Jericho H; Johncilla M; Johnson M; Kaukinen K; Levene A; Liptrot S; Lu L; Makharia GK; Mathews S; Mazzarella G; Maxim R; La Win Myint K; Mohaghegh-Shalmani H; Moradi A; Mulder CJJ; Ray R; Ricci C; Rostami-Nejad M; Sapone A; Sanders DS; Taavela J; Volta U; Walker M; Derakhshan M; Witteman B
    Background: Histological changes induced by gluten in the duodenal mucosa of patients with non-coeliac gluten sensitivity (NCGS) are poorly defined. Objectives: To evaluate the structural and inflammatory features of NCGS compared to controls and coeliac disease (CeD) with milder enteropathy (Marsh I-II). Methods: Well-oriented biopsies of 262 control cases with normal gastroscopy and histologic findings, 261 CeD, and 175 NCGS biopsies from 9 contributing countries were examined. Villus height (VH, in μm), crypt depth (CrD, in μm), villus-to-crypt ratios (VCR), IELs (intraepithelial lymphocytes/100 enterocytes), and other relevant histological, serologic, and demographic parameters were quantified. Results: The median VH in NCGS was significantly shorter (600, IQR: 400−705) than controls (900, IQR: 667−1112) (p < 0.001). NCGS patients with Marsh I-II had similar VH and VCR to CeD [465 µm (IQR: 390−620) vs. 427 µm (IQR: 348−569, p = 0·176)]. The VCR in NCGS with Marsh 0 was lower than controls (p < 0.001). The median IEL in NCGS with Marsh 0 was higher than controls (23.0 vs. 13.7, p < 0.001). To distinguish Marsh 0 NCGS from controls, an IEL cut-off of 14 showed 79% sensitivity and 55% specificity. IEL densities in Marsh I-II NCGS and CeD groups were similar. Conclusion: NCGS duodenal mucosa exhibits distinctive changes consistent with an intestinal response to luminal antigens, even at the Marsh 0 stage of villus architecture.